Thoracic Outlet Syndrome
Thoracic outlet syndrome is a group of conditions involving the compression of blood vessels and nerves within the thoracic outlet, the space between the collarbone and ribs. This condition commonly develops as a result of trauma from an accident or recurring injuries to the area. Symptoms of thoracic outlet syndrome can vary depending on the type and severity of the condition, but often include numbness or tingling in the fingers, pain in the shoulder and neck and a weak grip for nerve-related conditions, and discoloration of the hand, pain and swelling in the arm and throbbing pain in the collarbone for vascular-related conditions.
Thoracic outlet syndrome (TOS) can manifest itself as predominantly affecting the brachial plexus (the nerves), the vein (resulting in clotting) , or the artery. The nerve compression is the most common of the three, comprising well over 90% of all TOS cases. For TOS affecting the vein or the artery, surgical treatment is the preferred approach to minimize recurrence and complications. For neurogenic (affecting the brachial plexus), conservative measures, prime among which is physical therapy, is usually recommended first. However, for many patients, there is a limited response with physical therapy particularly if the symptoms are very clearly due to brachial plexus compression. Surgery can have a very good result in carefully selected patients.
Causes and Treatment of Thoracic Outlet Syndrome
Treatment plans for thoracic outlet syndrome may include physical therapy which helps strengthen the muscles of the shoulder and improves range of motion. Pain medication may also be recommended. Surgery may be needed if physical therapy does not improve the condition. There are several possible types of procedures, depending on the circumstances of the case. These include bypass surgery to reroute blood around a compression or to remove the area causing the symptoms, a segment of the first rib removed to release pressure in the area, or an extra rib removed and specific muscles cut. Other alternatives may be recommended, including angioplasty which is a procedure to mechanically widen a narrowed or obstructed blood vessel.
Blood vessels and nerves coming from the spine pass through a narrow space in the shoulder and armpit area on their route to the arms. As they pass through or by the collarbone and upper ribs, they may be hampered by not enough space. Pressure or compression of these blood vessels and nerves thus result in symptoms to the arms and hands. Thoracic outlet syndrome is almost always a problem having to do with these nerves.